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Value-Based Care

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Brief

This toolkit outlines state options to address Medicaid spending without harming enrollee health and provider stability and access to care.

Commentary

This commentary discusses the importance of waiving costs for COVID-19 testing.

Report

02.2021 / By Milbank Memorial Fund

This issue brief summarizes the current landscape of payment reform initiatives addressing social determinants of health.

Report

This report identifies six connected strategies to guide payers, including Medicaid agencies and managed care organizations, in developing equity-focused value-based payment approaches to mitigate health disparities at the state and local levels.

Report

This report describes a model estimating program spending and out-of-pocket spending by Medicare Advantage enrollees at the county level using plan-level and county-level data sources from the Centers for Medicare & Medicaid Services.

Report

This report describes how the COVID-19 pandemic financially affected five safety net hospitals as of summer 2020, including the costs of preparing for and operating during the pandemic, the pandemic’s impact on their revenues, the federal financial relief they have received, and implications for policy and practice.

Webinar & Presentations

This webinar features experts reviewing the provisions of the No Surprises Act and implications for states, providing an overview of the next steps for implementing the federal balance billing protections and what the law will mean for state-level protections.

Commentary

This commentary analyzes the indirect costs of rising health care spending and uninsurance in the year prior to the COVID-19 pandemic and examines trends as well as comparisons across race/ethnicity and educational attainment.

Commentary

This commentary reviews the key features of the Community Health Access and Rural Transformation Model, an initiative of the Centers for Medicare and Medicaid Services, and outlines considerations for states.

Brief

This brief explores the key challenges faced by the rural ambulatory safety net in delivering primary care and behavioral health services since COVID-19 and the policy changes that have been implemented in response.

Webinar & Presentations

This tool helps states gather detailed information from hospitals about their community benefit expenditures and activities during the pandemic.

Report

This report explores the strengths and deficiencies of maternal health care financing in the United States and the ways current policies and practices contribute to inequitable maternal health outcomes.

Commentary

This commentary discusses how, as development of a COVID-19 vaccine continues, states are racing to develop vaccine distribution plans.

Webinar & Presentations

This webinar explores the Buying Value suite of resources to support states' use of performance measures as they assess and improve value with managed care plans and accountable provider entities. 

Commentary

This commentary examines how proposals to protect patients from aggressive medical debt collection during the COVID-19 pandemic could serve as a model for the future.

Webinar & Presentations

This webinar features experts reviewing examples of specific strategies states implemented between April and August 2020 to increase payments to providers in financial distress as a result of decreased health care utilization.

Report

This report features lessons learned from Arizona and Michigan and supplements earlier materials on building complex care programs and using a housing as health care approach for complex care populations.

Commentary

This commentary explores the key role Medicaid programs play in helping the health care system make the transition to the new normal of the COVID-19 crisis.

Webinar & Presentations

This webinar walks through tools states can use to increase payments to providers through both fee-for-service and Medicaid managed care, despite COVID-19 driven changes to utilization.

Report

This report examines examples from two state Medicaid programs and a nonprofit quality measurement and reporting organization of the data sources used to identify patients’ social risk factors when risk-adjusting payments or measuring quality.

Commentary

This commentary summarizes recent guidance from the Centers for Medicare & Medicaid Services on permitting health insurance issuers to provide certain premium rebates for 2020 and the conditions rebates must meet.

Commentary

This commentary discusses how potential requirements for workplace coronavirus testing may force essential workers to bear a disproportionate share of the cost.

Report

This report examines activity across six states that are exploring social insurance initiatives to help finance long-term services and supports.

Report

This report uses new data from the first wave of the Urban Institute’s Coronavirus Tracking Survey to examine health care affordability problems and avoidance of care due to concerns about exposure to COVID-19.

Commentary

This commentary revisits the history of certificate-of-need and state health planning efforts to inform future decisions as hospitals and state policymakers plan for a post-COVID-19 health care system.

Commentary

This commentary assesses how insurers are developing their 2021 premium rates by reviewing preliminary actuarial findings in the District of Columbia, New York, Oregon, Vermont, and Washington.

Commentary

This commentary provides an overview of CMS relief guidance and flexibility to state hospitals, facilities, and providers on reporting measures for value-based purchasing and quality reporting programs.

Commentary

This commentary assesses how the COVID-19 pandemic may accelerate a shift away from fee-for-service payments models in health care.

Report

This report documents access and affordability challenges facing uninsured new mothers using 2015–18 data from the National Health Interview Survey (NHIS). It also uses 2015–17 data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) to describe the health status of women who lost Medicaid coverage following their pregnancies.

Dataset

This chart details recent state actions affecting health insurance in response to COVID-19.

Commentary

This commentary discusses the need for states to be sound stewards of taxpayer dollars and why the need to do so now is particularly acute as states confront financial landscapes devastated by the pandemic.

Report

In this report, researchers estimate the fiscal impacts of several approaches for increasing federal Medicaid matching rates, providing state-level estimates for each approach.

Commentary

This commentary discusses the huge rise in the number of people without health insurance in the wake of mass layoffs resulting from the COVID-19 pandemic and are seeking strategies to protect them from high prescription drug prices.

Commentary

This commentary highlights the promise and challenge of telehealth tools, including unconventional uses of telehealth technology, scalability of interventions, the effect of patient preferences on behavior adoption, and the effect of patient demographics on adoption. 

Report

This report assesses the cost of Medicaid relative to private insurance in the health insurance landscape under the Affordable Care Act (ACA).

Brief

This brief gives an overview of the multiple actions states are taking toward ensuring accessible coronavirus (COVID-19) testing and cross-agency collaboration. 

Commentary

This blog post discusses the challenges and risks associated with implementing cost-sharing requirements for COVID-19 testing and treatment, and the implications that these requirements may have in individuals delaying or avoiding care altogether.

Dataset

This resource identifies areas where states are doing well and areas where they can improve on healthcare affordability.

Report

12.2019 / By Manatt Health

This report investigates the health care cost benchmarking programs adopted in Massachusetts and Oregon.

Brief

This blog from the Delta Center illustrates five key insights related to program design and evaluation from the productive partnership between the Partnership HealthPlan of California (PHC) and local community health centers (CHCs) to create a care coordination (CCM) program.

Report

This report investigates what is motivating states to transition to full state-based marketplace status, assesses the benefits and risks of such a switch, and identifies considerations for other states considering a similar move.

Report

This report provides an overview of the behavioral health system’s engagement in Medicaid value-based payment (VBP) models and provides policy recommendations to support VBP adoption.

Report

09.2019 / By Urban Institute

This report updates previous analysis of the coverage and health spending implications of Healthy America and analyzes two additional options: one without an individual requirement and one that would lead to universal coverage for all legal residents of the US.

Report

This report examines implementation considerations for fiscal mapping from sites in Maryland and Minnesota to help inform similar mapping activities in additional states and communities.

Report

07.2019 / By Urban Institute

This report examines a potential reform to Medicare that would simplify coverage for fee-for-service beneficiaries; streamline cost-sharing obligations for Medicare Parts A, B, and D; and create an out-of-pocket maximum.

Commentary

This commentary outlines ways in which Congress can look to actions by state-level policymakers for guidance on how to achieve legislative compromise on balance billing.

Dataset

06.2019 / By Altarum

This resource calculates the cost of lead exposure in states, and computes the economic benefits of specific policies and programs, from replacing lead drinking water service lines to eradicating lead paint hazards in older homes.

Report

In this report, insurance experts share findings from a case assessing New York’s experience with its Surprise Billing law, five years in.

Brief

This issue brief looks at progress made in using multi-payer claims databases for various strategic purposes, and offers considerations for states seeking to optimize claims databases to improve health care system performance improvement.

Journal Article

This article estimates the costs of implementing state-based reinsurance programs in four large states whose size provides a useful cost-projection base for other state policymakers considering reinsurance programs.

Webinar & Presentations

This webinar explored how several states are using their multi-payer claims databases, including how they are employing claims databases to enhance the value of care and lessons learned for others.

Commentary

This commentary explores a series of case studies and tools developed after a national scan of promising HC/CBO partnerships that examine the operational, financial, and strategic components of successful partnerships.

Dataset

This tool includes more than 700 measures and the most up-to-date version of 19 federal and other national measure sets and six state measure sets.

Dataset

This database includes non-HEDIS and modified HEDIS measures in use by state purchasers and regional health improvement collaboratives and associated performance levels.

Commentary

This commentary provides a brief background on the recent litigation surrounding cost sharing reductions, including executive actions, and state and insurer responses, as well as what could happen next.

Brief

This brief reviews considerations for policymakers assessing their state Medicaid managed care programs and exploring strategies for advancing cost, quality, and accountability goals.

Commentary , Dataset

The percentage of the U.S. population that made changes to drugs due to cost has been relatively stable over time at the national level, but there are substantial differences by state and significant disparities exist between age groups and types of insurance coverage.

Report

02.2019 / By Urban Institute

This report finds between 2006 and 2017, growth in spending per enrollee in Medicare and Medicaid was much slower than in private insurance.

Report

This report explores options for states as they consider oversight of risk-bearing organizations (RBOs), with a focus on states that have elected to act to protect against provider insolvency. The State Health Policy Highlight reviews specific state considerations when overseeing RBOs; case studies examine approaches in California, Massachusetts, New York and Texas.

Brief

State officials can align prevention strategies with value-based payment goals through a variety of mechanisms outlined in this brief, which draws from state-based 6|18 Initiative implementation efforts to help Medicaid and public health officials make the case for investing in prevention strategies and aligning these efforts to achieve state VBP goals.

Report

This issue brief provides an overview of hospital global budgeting, which represents a middle-ground approach between the narrow bundling of services and global capitation that transfers higher levels of financial risk to a hospital. It provides a brief overview of hospital global budgets for state health officials interested in whether global budgets may be an option for their state.

Brief

In Morrison County, Minnesota, an innovative state approach to improve population health is also helping combat the opioid crisis and save money. The Unity Accountable Community for Health (ACH) initiative has saved the state’s Medicaid program $3.8 million over three years by reducing claims for prescription opioid and related drugs.

Report

The Health Care Payment Learning and Action Network Alternative Payment Models Framework (the LAN APM Framework) is an increasingly common method being used by states to measure plan progress toward implementation of APMs. This report provides real-world examples of APMs within the LAN categories and can help states and other interested purchasers develop a common understanding of what types of payment models fit within the framework categories.

Report

This report highlights policy levers, performance measurement strategies, and sustainable financing options that states can use to support accountable health structures.

Webinar & Presentations

This webinar features the Urban Institute's Dr. Fred Blavin, whose SHARE-funded research asks how medical spending burdens for near-poor families in non-expansion states would change if the states were to expand Medicaid.

Report

This report provides an overview of three areas of value-based innovation and then affords a deeper examination into specific examples of state employee purchaser activity in California, Connecticut, Massachusetts, Minnesota, Tennessee, and Washington.

Brief

More than 200 state health officials crowded into a NASHP annual conference session to learn about strategies to improve population health and reduce costs while simultaneously transforming their state’s health care finance and delivery models.

Report

This toolkit is designed to assist states interested in implementing value-based purchasing approaches with their Medicaid managed care organizations (MCOs). Using a value-based purchasing approach can mean significant and ongoing changes for a state Medicaid agency and its MCOs.

Brief

This blog reviews cost-sharing reduction (CSR) programs designed to reduce the cost of insurance for consumers purchasing policies on individual markets.

Report

The Partnership for Healthy Outcomes set out to capture and analyze the lessons emerging in this dynamic space, as organizations explore partnerships to achieve greater outcomes together than they could on their own. A national request for information asked specifically about partnerships between health care organizations and CBOs. It produced a wealth of data from a wide range of partners in a wide variety of partnerships.

Brief

Under the authority of Section 1115 demonstrations, some states have implemented DSRIP programs to improve care, improve health, and lower costs. DSRIP programs restructure Medicaid funding into a pay-for-performance arrangement in which providers earn incentive payments outside of capitation rates for meeting certain metrics or milestones based on state-specific needs and goals, which are used to measure success.

Report

Driven to improve care coordination and contain costs by moving away from a volume-based payment model, an increasing number of states are implementing risk-based managed care programs to deliver long-term services and supports (LTSS). As the primary payer for LTSS, state Medicaid programs have a significant interest in ensuring that entities with which they contract deliver high quality and cost-effective care to members. This report identifies ways states can learn from value-based payment models being applied elsewhere to create more accountability for the quality and cost of LTSS.

Brief

Recent state waivers can inform the question of whether and how low-income individuals could benefit from health savings accounts (HSAs) with high-deductible health plans. State experiences incorporating health savings accounts into Medicaid can be instructive, as policymakers consider the role of HSAs in proposed health care reforms. This brief looks at health savings and similar accounts in Michigan and Indiana.

Webinar & Presentations

The “Buying Value Measure Selection Tool” was developed to assist state agencies, private purchasers and other stakeholders in creating aligned measure sets, and was first released in 2014. This webinar explains this tool and recent updates for state officials and other stakeholders involved in developing and maintaining aligned quality measure sets for health care entities and programs including for health plans, accountable care organizations, and patient-centered medical homes. This webinar presents strategies for selecting measures and reveals an updated version of the tool. 

Brief

Leaders from across state governments, in both the executive and legislative branches, convened to help identify cross-cutting issues that provide opportunities to advance health reform and transform our health system to one that lowers cost, rewards value, and improves health. This brief presents key opportunities before the new administration that could maintain and accelerate state-based reforms.

Report

This report identifies methodological challenges in measuring cost of care performance for organizations with a small number of attributed patients, and provides concrete strategies and resources for state purchasers to address this methodological challenge when evaluating PCMH and ACO cost performance and applying financial incentives and disincentives.

Brief

Changes in population-based payment models in health care delivery have spurred enhanced efforts toward closer integration between state purchasers of health care and state, county, and local public health officials. This issue brief investigates approaches that state agencies might employ in order to better integrate public health and health care delivery as a means of improving health and the value of health care, and it is organized according to seven features of integration. The issue brief is accompanied by three case studies providing additional detail to some of the examples cited in the brief.

Brief

In this brief, we explore two revenue sources states may deploy to fund the non-federal share of expansion: provider assessments and provider donations. Both are authorized by federal law and both have been used by states in connection with expansion.

Brief

This issue brief examines seven safety-net ACOs across five states to understand their origins, organization, characteristics and functions and to identify federal and state policy questions associated with their emergence. The issue brief identifies both challenges facing safety-net provider ACO aspirants and state strategies to support safety-net provider development of ACOs.

Report

This report identifies key lessons from ACO activities across the country to date. It examines how ACOs can build upon these initial successes and informs policymakers, researchers, and foundations about key considerations to further the development of effective ACO approaches across the health care market.

Brief

As state Medicaid programs increase their focus on value-based payment, it is important to consider how FQHCs may participate in payment reform strategies. Through their focus on improved health outcomes, patient satisfaction, and access to appropriate care, alternative payment methodologies can benefit FQHCs, the state purchaser, and most importantly Medicaid beneficiaries. This brief describes a number of state-level payment reform strategies that include FQHCs and offers strategies and considerations for states and FQHCs alike.

Report

This report stems from technical assistance provided to California’s Department of Health Care Services (DHCS). The technical expert facilitated webinars and meetings with DHCS staff and medical directors of contracted MCOs, in order to share information about housing resources and emerging practices for improving care and achieving savings by linking more Medicaid beneficiaries with permanent supportive housing.

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